Module 7 -Obesity and Energy Balance-1 PDF

02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 1 ENERGY BALANCE AND OBESITY 02/17/2020 Dr. Rebecca A Creasy 2 Learning Objectives 1. Explain th...

02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 1 ENERGY BALANCE AND OBESITY 02/17/2020 Dr. Rebecca A Creasy 2 Learning Objectives 1. Explain the relationship between energy balance and body weight. 2. List and describe the components of total energy expenditure. 3. Calculate BMI to determine if individual is underweight, normal weight, overweight or obese. 4. Discuss the relationship between location of excess body fat and risk of chronic conditions and mortality. 5. Define osteoporosis and list risk factors for the disease. 6. Discuss the causes of obesity. 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 3 Learning Objectives 7. Identify hormones and neurotransmitters that influence hunger/appetite and weight status. 8. Distinguish between hunger and appetite. 9. List reasons why fad diets are unsuccessful for long term weight loss. 10. Discuss the recommendations for successful long- term weight loss and maintenance in adults. 11. Recognize 3 different weight loss surgeries and how each may result in weight loss. 12. Describe the recommendations for treating childhood obesity. 02/17/2020 Dr. Rebecca A Creasy 4 Key Terms to Know Body Mass Index Essential fat Storage fat Visceral fat Subcutaneous fat Set Point Theory Adipocytes Leptin 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 5 Calories in versus calories out Weight management is related to kcal in vs kcal out Kcal Consumption = Kcal Expended Weight Maintenance Kcal Consumed < Kcal Expended Weight Loss Kcal Consumed > Kcal Expended Calories In Weight Gain Calories Out 02/17/2020 Dr. Rebecca A Creasy 6 Calories in: the food we eat Fast food and convenience foods may contribute excess kcal Fat and sugar Foods marketed as low-fat or fat-free can be deceiving. Calories may be equal to or greater than original product Other reasons for excess kcal: Larger portion sizes Easy to do when dining out 3  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 7 Calories In: Portion Size Changes Over Time 02/17/2020 Dr. Rebecca A Creasy 8 Calories In: Sugar sweetened beverages Sugar-sweetened beverages (SSBs) are one of the largest source of added sugar in diet. Adolescents who eliminated SSB from their diet for one year, gained on average 4 pounds less on average their SSB drinking peers (Ebbeling, N Eng J Med, 2012) 4  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 9 What 200 Calories Looks Like in Different Foods https://ww w.facebook.com/Aust.Sports.Nutrition/videos/10 153440267215292/?fref=nf\ 02/17/2020 Dr. Rebecca A Creasy 10 Calories out: energy expenditure Individuals vary widely in Calories burned each day. Calories (or energy) is expended in three ways: 1. Resting energy expenditure (REE) 2. Physical activity 3. Thermic effect of food (TEF) All together, this is: Total Energy Expenditure 5  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 11 Components of total energy expenditure Basal metabolic rate (BMR) Energy metabolism that occurs after waking in the morning, at least 12 hours after the last meal: Includes energy for functions that sustain life:  Breathing  Heart beat  Brain  Liver  Kidneys Resting energy expenditure (REE) Calories burned while sitting or sleeping; make up most of calories burned in a day Less restrictive 02/17/2020 Dr. Rebecca A Creasy 12 Components of total energy expenditure Physical activity Energy expenditure through voluntary physical effort, including daily activities, exercise, or physical labor Energy needed for muscle contraction. Factors influencing energy burned during exercise:  Body weight and muscle mass utilized  Duration of activity  Intensity of activity  Fitness level  Type of activity 6  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 13 02/17/2020 Dr. Rebecca A Creasy 14 Components of total energy expenditure Thermic effect of food (TEF) The process of burning calories as you digest, absorb, transport, store, and metabolize food. Body burns about 10% of calories consumed from meal. Diet can have a mild influence: A little higher for protein 7  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 15 Total energy expenditure 02/17/2020 Dr. Rebecca A Creasy 16 Estimating energy expenditure 1. Calculate BMR BMR for Women = 665.1 + (9.563 x weight in kg) + (1.85 x height in cm) − (4.676 x age) BMR for Men = 66.5 + (13.75 x weight in kg) + (5.003 x height in cm) − (6.775 x age) 2. Account for Physical Activity 8  02/17/20 20 Physical Activity Activity Factor Sedentary (little or no activity) 1.2 Lightly Active (light exercise/sports 1-3 days/week) 1.375 Moderately Active (moderate exercise/sports 3-5 1.55 days/week) Very Active (hard exercise/sports 6-7 days/week) 1.725 Extra Active (very hard exercise/sport and 1.9 physical 2/19/20 job or 2x daily training) Dr. Rebecca A 1 18 Creasy 7 02/17/2020 Dr. Rebecca A Creasy 18 Body mass index (BMI) The body mass index (BMI) is a measure of weight relative to height. Often used to diagnose overweight or obesity Standard formula to calculate BMI: Weight in kilograms /(height in meters)2 Result may suggest degree of excess body fat: 18.5 – 24.9: Normal body weight 25 – 29.5: Overweigh t over 30: Obese Under 18.5: Underweight 9  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 19 BMI and disease risk Being overweight or obese raises the risk for a number of diseases, such as: Cardiovascular disease Hypertension Type 2 diabetes Stroke Gallbladder disease Osteoarthritis Sleep apnea Respiratory problems Endometrial, breast, prostate, and colon cancers 02/17/2020 Dr. Rebecca A Creasy 20 BMI and mortality 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 21 Underweight BMI < 18.5 kg/m2 Negative consequences  Decreased overall energy  Respiratory complications  Heart irregularities  Infertility  Delayed wound healing  Weakened immune system  Osteoporosis 02/17/2020 Dr. Rebecca A Creasy 22 Underweight A condition associated with decreased bone mass and bone density that can result in increased risked of bone fracture is: Osteoporosis Those at greater risk for osteoporosis include:  Older age  Women  Being underweight  Tobacco use  Physical inactivity 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 23 Limitations of BMI Does not distinguish between fat and muscle mass −Athletes Various ethnicities Sex Elderly 02/17/2020 Dr. Rebecca A Creasy 24 Body composition Total body mass Lean tissue mass + fat mass + water Categories of body fat: Essential fat - fat required for normal physiological functioning Storage fat - fat in adipose tissue, tissue under the skin, and fat that “pads” essential organs Percent body fat differs with age and sex Body fat usually increases with age Women should have a higher body fat percentage than men 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 25 Body Composition 02/17/2020 Dr. Rebecca A Creasy 26 Body fat distribution Gynoid pattern: −Fat over muscle and under skin at hips and thighs Subcutaneous fat Android pattern: −Body fat can be stored under the abdominal muscle around the internal organs “Visceral fat” Associated with risk for chronic conditions due to excess fat. 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 27 Android vs. Gynoid 02/17/2020 Dr. Rebecca A 28 Creasy Visceral Fat Distribution 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 29 Obesity as a global issue Contrary to popular belief, the obesity epidemic is not just an issue for the United States and other industrialized societies Globesity Obesity not a problem for only adults Childhood obesity is an epidemic in some areas of the world and on the rise in others 02/17/2020 Dr. Rebecca A Creasy 30 Obesity: choice or destiny? While personal food and activity choices have a great deal to do with whether someone becomes overweight, choice is not the only factor Other factors that could affect weight include: Physiological Psychological Lifestyle behaviors Social and economic 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 31 Cause of Obesity Energetics − Obesity is caused by a positive energy balance that results from: Eating more calories than you burn It makes sense that an unbalanced energy equation is connected to weight gain 02/17/2020 Dr. Rebecca A Creasy 32 Cause of Obesity Environment: − As a society: We move less. We eat more. If part of social network is obese, Individual ideas of acceptable weight increases Healthy, affordable food hard to purchase in some areas 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 33 Cause of obesity Genetics −The theory that the body is programmed to gravitate toward a particular weight. Set point theory − Metabolism may adjust upward or downward to ensure that weight is neither gained nor lost. When a person gains weight in the form of fat, both the number and the size of fat storing cells, also known as: Adipocytes 02/17/2020 Dr. Rebecca A Creasy 34 Causes of obesity Hormone Imbalance −Hormone released by fat cells to signal the brain that the body has had enough to eat: leptin levels of leptin results in: food intake energy metabolism Long term weight control 1  02/17/20 20 02/17/2020 35 Effects of Leptin Dr. Rebecca A Creasy 02/17/2020 Dr. Rebecca A Creasy 36 Weight Management: A Balancing Act Hunger, Appetite, and Satiety Eating behavior combination of physiological and psychological signals integrated in hypothalamus of brain Hunger vs. appetite Hunger is the need to eat May be triggered by low blood glucose and low glycogen Appetite is the desire to eat Triggered by sight/smell of food 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 37 Short term regulation of hunger Compound (neurotransmitter) that increases food intake and blood glucose levels, promoting the storage of energy in fat cells: Neuropeptide Y A hunger-stimulating hormone produced by cells lining the stomach when stomach is empty Ghrelin Increased hunger After eating, release ghrelin with weight loss 02/17/2020 Dr. Rebecca A Creasy 38 Why don’t diets work? Unrealistic and difficult to follow long term Many categorize foods as “good” or “bad” and encourage dieters to eliminate certain foods. Key to success of weight loss or maintenance Establish diet and physical activity plans that can be followed for a lifetime 1  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 39 02/17/2020 Dr. Rebecca A Creasy 40 What does work for weight loss/weight management? The best weight loss regimens: Promote small, moderate lifestyle changes To reduce energy in and increase energy burned: portion size daily physical activity 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 41 Decrease Calorie Intake A balanced diet integrating all food groups is encouraged to promote long-term weight management Consume more of the following: Fruits, vegetables and whole grains Low-fat dairy choices Protein from lean meats and vegetable source Monounsaturated and polyunsaturated fats in place of saturated fat 02/17/2020 Dr. Rebecca A Creasy 42 Physical Activity Incorporate planned physical activity into daily routine Overall health: Moderate activity 30 minutes, 5 days/week Maximum cardiovascular benefit: Vigorous activity for minimum of 20 minutes/session Exercise for weight loss requires combination of activities Aerobic activity to burn calories Strength training to build muscle 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 43 Behavior When you are trying to lose weight it is just as important to examine why you eat as what you eat: Social cues Family traditions Holiday celebrations and parties Media Emotional cues Stress Boredom 02/17/2020 Dr. Rebecca A Creasy 44 Satiety Hunger Food Intake Cycle Satiation Seek food Keep Eating 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 45 Medications to treat obesity Drug therapy often used as a component of weight- loss treatment. Recommended when: person is extremely obese life-threatening health complications exist Is not a permanent solution Ineffective without diet, physical activity and behavior modification www.medscape.com 02/17/2020 Dr. Rebecca A Creasy 46 Weight Loss Surgery Surgery as a treatment for obesity is growing in popularity. Candidates for weight loss surgery: BMI > 40 kg/m2 BMI > 35 kg/m2 + related health conditions 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 47 Weight Loss Surgery Vertical Sleeve Gastrectomy: Part of stomach removed Small stomach = less room for food (restriction) Adjustable Gastric Band Procedure Adjustable band fits around upper part of stomach Restriction Roux-en-Y Gastric Bypass Small pouch created from stomach Part of small intestine bypassed Restriction and malabsorption 02/17/2020 Dr. Rebecca A 48 Creasy Weight loss surgeries Vertical Adjustable Gastric Gastric Gastric Bypass Sleeve Banding 2  02/17/20 20 02/17/2020 Dr. Rebecca A Creasy 49 Treating childhood obesity Caution must be used when treating overweight and obese children Caloric restriction can inhibit growth during rapid development phases General recommendations: weight maintenance is advised gain height and grow into their weight 2